HomeMy WebLinkAboutInsurance Certificate: Engineered Monitoring Solutions
Ci"({ RECORDER
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
TM. 1210212009
PRODUCER Phone: 503-365-7001 Fax: 503-365-7354 nns CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION
MID VALLEY GENERAL AGENCY LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4305 RIVER ROAD N , - .. ~~~!R':u~IS CERTIFICATE DOES ~.?~E:M~~;..,;~~~?, ~~ _
KEIZER OR 97303 . ,
INSURERS AFFORDING COVERAGE - .. .. NAIC#-
..,
.. .
:
INSURED INSURER A: SCOTTSDALE INSURANCE COMPANY 41297
ENGINEERED MONITORING SOLUTIONS LLC INSURER B: --.
20345 SW PACIFIC HWY, SUITE 104 INSURER C:
SHERWOOD OR 97140
INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF At{'( CONTRACT OR OTHER DOCUMENT 'MTH RESPECT TQWHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHm\tJ MAY HAVE eEEN R!:DUCED BY P~!D CLAIMS
'"'" Ir.cmI TYPE OF INSURANCE POLICY NUMBER "g~i~~~~ ~~,~:U~N LIMITS
em '"'"
~ERAL LIABILITY CPS1104202 12/03/09 12103/10 EACH OCCURRENCE . 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED . 100,000
PREMISES{Eaoceu'''nce)
I CLAIMS MADE0 OCCUR MED, EXP {Anyone person) . 5,000
A - PERSONAL & ADV INJURY . 1,000,000
- , GENERAL AGGREGATE . 2,000,000
~'~I AGGREGATE LIMIT APPn:ER PRODUCTS+COMPfOP AGG. . 2.000,000
-- n PRO- . --
POLICY JECT lOC
~OMOBILE UABILlTY .
COMBINED SINGLE LIMIT
(Eaaccident) .
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY
(Per person) .
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(per accident) .
- NON-OWNED AUTOS
- PROPERTY DAMAGE .
(Per accident)
~GE UABIUTY AUTO ONLY - EA ACCIDENT .
ANY AUTO OTHER THAN EA ACC .
AUTO ONLY: AGG .
~ESS I UMBRELLA LIABILITY EACH OCCURRENCE .
OCCUR 0 CLAIMS MADE AGGREGATE .
I . ---
~ DEDUCTIBLE .
RETENTION $ .
WORKERS COMPENSATION AND I~T~~S I lOnER
EMPLOYERS' liABILITY
AtNPROPRlETOR/PARTNERlEXECVTtVE E.L. EACH ACCIDENT .
OFFICER/MEMBEREXCLUDED? E,L. DISEASE-EA EMPLOYEE .
If yes, describe under E.L. DISEASE-POLICY LIMIT .
SPEClAL PROVISIONS below
OTHER:
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CITY OF ASHLAND IS INCLUDED AS ADDITIONAL INSURED PER CG2010(7/04)
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
90 N MOUNTAIN AVE EXPIRATION DATE THEREOF, THE ISSUING INSURER \I\lLL ENDEAVOR TO MAIL 30 DAYS
WRITIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
ASHLAND, OR 97520 DO SO SHALL IMPOSE NO OBLIGATION OR L1ABIL!TY OF ANY KINO UPON THE INSURER, Irs
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
MID VALLEY GENERAl AGENCY \-l ,e. 0~,'
LlC 4"
Attention: KARl OLSON Herman R Deiss
ACORD 25 (2001108)
Certificate #
43194
@ACORDCORPORATION1988
~ ~ (t:,C'"-1~:':.:L""'';'''-f:/
~r<L-A_ C-4LPi<~.&~
, .
POLICY NUMBER CPS1104202
EINGINEERED MONITORING SOLUTIONS, LLC
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Location(s) Of Covered ODerations
Or Organization(s):
CITY OF ASHLAND
90 N MOUNTAIN AVE
ASHLAND, OR 97520
ATTN:KARIOLSON
POLICY PERIOD: 12-03-2009 TO 12-03-2010
Information recuired to comDlete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above.
CG 20 10 07 04
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf of
the additionai insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
tended use by any person or organization other
than another contractor or subcontractor en-
gaged in performing operations for a principal
as a part of the same project.
@ ISO Properties, Inc., 2004
o
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